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Billing and Reporting

Billing and Reporting

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Billing and Reporting

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  1. Billing and Reporting Title V MCH FEE, PHC, BCCC Deborah Lewis, Program Specialist

  2. Billing and Reporting CHS Contract Management Home Page • http://www.dshs.state.tx.us/chscontracts/ default.shtm • Click on Forms • All report forms are available • Contractor Vouchers and Reporting

  3. Title V MCH Fee for Service • Accessing Procedures Manual • Forms and Instructions • Submitting Reports • Report Approvals • Common Questions • Common Errors • Contacts

  4. Title V MCH Fee for Service Accessing Policy & Procedure Manual http://www.dshs.state.tx.us/mch/fee/policy.shtm Section 2 – Performance Management Billing & Reporting

  5. Title V MCH Fee for Service Forms and Instructions • Monthly Reimbursement Request (MRR) • Identifying information found on cover pages 1 & 2 of the contract

  6. Title V MCH Fee for Service Identifying Information – Example 1 • Contract term runs September – August • Payee Name, Contractor Name, Address, and Payee Vendor ID # must agree • Payee Vendor ID # is 14 digits • DSHS Funding is already completed on the downloaded Excel File • Purchase order # is 10 characters

  7. Title V MCH Fee for Service Identifying Information (continued) • DSHS Document # is 10 digits based on Tax ID and may have an alpha character • Year – Attachment # is 4 digit year – 2 digit attachment # • As contract amendments are fully executed, a 1 up alpha character will be added to the attachment # • Period cover by this report is MO/YR • Prepared By and Phone number should be completed on each page • Processed by line should be left blank

  8. Title V MCH Fee for Service Review Components of 185 • Age group 1-21 • Watch for Case Management • Watch for lab billing included with Prenatal visits • Make sure billing is in accordance with Service Delivery Plans (SDP)

  9. Title V MCH Fee for Service Review Components of 186 • Infants 0 – 11 months • Women over 21 • Watch for Case Management • Watch for lab billing included with Prenatal visits • Make sure billing is in accordance with Service Delivery Plans (SDP)

  10. Title V MCH Fee for Service Special Services Report (SSR) • Billing for Genetic Services • Page may be eliminated in FY 07

  11. Title V MCH Fee for Service Review Monthly Activity Report (MAR) • Counts start over in September for each service • Each person should be counted one time per service per year • Counts on the MAR should coincide with age group billing

  12. Title V MCH Fee for Service Submitting Monthly Reports • Table is in the Manual Section 2 Page 1 • Due 30 days following the end of the month • MRR emailed to the Central Processing Unit (CPU) at invoices@dshs.state.tx.us, or faxed to 512-458-7442 • MRR, 185, 186, SSR (if applicable), MAR faxed to 512-458-7235 • Please submit all pages simultaneously

  13. Title V MCH Fee for Service My Spreadsheet • Shows report approval date • Tracks all expenditures • Monitors expenditure levels • Monitors 185 & 186 for 25% spending on ages 1-21 • Tracks performance measures

  14. Title V MCH Fee for Service Common Questions Q. Can co-pays be charged? A. Yes up to 25% of the reimbursable amount Q. Can the 25% requirement be annualized? A. Yes the requirement is on a state wide basis Q. Should co-pays for flu vaccine be reported as program income A. No co-pays for flu vaccine should not be reported as program income because it is not a reimbursable expense

  15. Title V MCH Fee for Service Common Errors • Incorrect form submission • Missing report pages • Pages indicate different periods covered • Identifying information incorrect

  16. Title V MCH Fee for Service Common Errors (continued) • Billing for labs inappropriately • Billing for services outside the SDP • Unduplicated client counts inconsistent with billing • Counts not started over in September

  17. Title V MCH Fee for Service Making Corrections • If the correction is requested, only submit affected pages • If the correction is discovered, correct the next monthly billing

  18. Title V MCH Fee for Service Payment Complications • Purchase order adjustments for program code • Purchase order adjustments for funding source

  19. Title V MCH Fee for Service Annual DSHS Form GC-10 (270) • PDF File • http://www.dshs.state.tx.us/grants/forms.shtm • Revisions still need to be addressed • This form should be used in the interim

  20. Title V MCH Fee for Service Instructions for the 270 Report • In box 1b place X in the final box • In box 4 enter Vendor ID • In box 8 enter contract term • In box 9 enter name and address • In box 13 sign, date, type, or print name, title and phone number

  21. Title V MCH Fee for Service Instructions for 270 (continued) • Total Reimbursable Services – after 2.5% reduction not to exceed contract amount • Less Program Income (PI) • Expected Total Payment Amount • Total PI Available is the same as program income • PI Expended usually is the same as PI available • PI to be refunded is usually zero • Disregard the second page for cash on hand

  22. Title V MCH Fee for Service Annual Report Submission • Table is in the Manual Section 2 Page 2 • Due no later than 90 days after the end of the contract term • Original signatures required • Mail two separately to: DSHS CPU mail code 1940 and CMB mail code 1914 1100 W. 49th St Austin, TX 78756

  23. Title V MCH Fee for Service Contacts • Deborah Lewis 512-458-7781 Program review questions • Grisilda Porter 512-458-7111 ext 2940 Payment status questions • Millicent Wilkins 512-458-7111 ext 2285 Vendor ID questions • Gina Baber 512-458-7111ext 6445 Contract Amendment questions • Travis Duke 512-458-7111 ext 3157 Policy questions

  24. Title V MCH Fee for Service Questions & Answers • Making the pieces fit

  25. Primary Health Care (PHC) • Accessing Procedures Manual • Forms and Instructions • Submitting Reports • Report Approvals • Common Errors • Contacts

  26. Primary Health Care (PHC) Accessing Policy & Procedure Manual http://www.dshs.state.tx.us/phc/pandp.shtm Section 2 – Performance Management Billing & Reporting

  27. Primary Health Care (PHC) CHS Contract Management Home Page • http://www.dshs.state.tx.us/chscontracts/ default.shtm • Click on Forms • Click on Primary Health Care to access all PHC forms • Click on Contractor Vouchers and Reporting for report submission instructions

  28. Primary Health Care (PHC) Forms and Instructions • Monthly Reimbursement Request (MRR) • Identifying information found on cover pages 1 & 2 of the contract • Approved budget found on attachment page 4

  29. Primary Health Care (PHC) Identifying Information – Example 1 • Contract term runs September – August • Payee Name, Contractor Name, Address, and Payee Vendor ID # must agree • Payee Vendor ID # is 14 digits • DSHS Funding should be CHS/PHC • Purchase order # is 10 characters

  30. Primary Health Care (PHC) Identifying Information (continued) • DSHS Document # is 10 digits based on Tax ID and may have an alpha character • Year – Attachment # is 4 digit year – 2 digit attachment # • As contract amendments are fully executed, a 1 up alpha character will be added to the attachment # • Period cover by this report is MO/YR • Prepared By and Phone number should be completed on each page • Processed by line should be left blank

  31. Primary Health Care (PHC) Approved Budget – Example 2 • Found in the contract attachment Section III page 4 (usually the last page) • The total goes in the TDH Funding block above the word Salaries • MRR amounts should match quarterly FSR amounts • Budget variances must stay within the 10% budget variance rule

  32. Primary Health Care (PHC) Contract Amendments Impact the MRR • Changes occur when contract is fully executed • Attachment always changes with 1 up alpha character • TDH Funding block changes if applicable • Approved Budget amount changes if applicable

  33. Primary Health Care (PHC) Types of PHC Clients • Full Service – only eligible for PHC • Supplemental Service – eligible for PHC but as a supplemental funding • Presumptive Eligibility – Presumed eligible for PHC for up to 90 days (only used if there is an immediate medical need prior to the completion of the eligibility process)

  34. Primary Health Care (PHC) Review Monthly PHC 200 • Question 1 refers to monthly eligibility screening • Questions 2 & 3 refer to monthly enrollment & re-certification • The sum of 2 + 3 should always be less than, or equal to the sum of 1b + 1C

  35. Primary Health Care (PHC) Review Monthly PHC 200 (continued) • Question 4 refers to the number of PE’s on PHC during the month • Question 5 is the unduplicated YTD count • Question 6 is the number of visits each month

  36. Primary Health Care (PHC) Submitting Monthly Reports • Table is in the Manual Section 2 Page 1 • Due 30 days following the end of the month • MRR emailed to the Central Processing Unit (CPU) at invoices@dshs.state.tx.us, or faxed to 512-458-7442 • MRR and PHC 200 faxed to 512-458-7235 • Please submit all pages simultaneously • Only submit revised pages when corrections are requested

  37. Primary Health Care (PHC) My Spreadsheet • Shows report approval date • Tracks all expenditures & quarterly balances • Monitors expenditure levels • Tracks performance measures • Tracks quarterly & annual report submission

  38. Primary Health Care (PHC) Common Errors on Monthly Reports • Incorrect form submission • Missing pages • Identifying information incorrect • Budget & TDH Funding incorrect • Cumulative amounts incorrect • 1b + 1c less than 2 + 3

  39. Primary Health Care (PHC) Common Errors on Monthly Reports (continued) • Incomplete forms, or blanks • Incorrect totals on PHC 200 • Decrease in Year-to-Date totals • Counting clients not specified in the SDP • Dates don’t coincide

  40. Primary Health Care (PHC) Making corrections • If the correction is requested, only submit affected pages • If the correction is discovered, correct the next monthly billing

  41. Primary Health Care (PHC) Quarterly PHC 301 • List the YTD cost of PHC services • List the YTD number of services provided • Calculate the cost per unit of Service (cost divided by number)

  42. Primary Health Care (PHC) Submitting the Quarterly PHC 301 • Table is in the Manual Section 2 page 2 • Due via fax to CMB at 512-458-7532 • Due Dec 31, Mar 31, June 30, & Sept 30

  43. Primary Health Care (PHC) Common PHC 301 Errors • YTD cost of services are not YTD • Number of services should not be an unduplicated count • Incorrect unit cost calculations

  44. Primary Health Care (PHC) Quarterly DSHS Form GC-4a (269a) • Financial Status Report • Excel file • http://www.dshs.state. tx.us/grants/forms.shtm • Revisions will be minimal

  45. Primary Health Care (PHC) Instructions for the Quarterly FSR 269a • Complete Identifying information at the top • Approved budget should match the most current fully executed contract • DSHS share should never exceed the contract amount • Reimbursements should show the amount you expect to receive for the quarter • Complete bottom portion, sign, and date

  46. Primary Health Care (PHC) Quarterly FSR 269a Report Submission • Table is in the Manual Section 2 page 2 • Due Dec 31, Mar 31, June 30, and Nov 30 • Original signatures required • Mail two separately to: DSHS CPU mail code 1940 and CMB mail code 1914 1100 W. 49th St Austin, TX 78756

  47. Primary Health Care (PHC) Common Errors on the FSR 269a • Incomplete, or inaccurate Identifying Data • Incorrect approved budget • Expenditures and income don’t match the MRR • DSHS share exceeds the contract amount • Reimbursements don’t include expected amounts

  48. Primary Health Care (PHC) Annual PHC 300 Tips • #1-#2 totals should tie with question # 5 on the August PHC 200 • #3 totals for both race and ethnicity should each tie with #1-#2 • #4 totals should add to equal #1-#3

  49. Primary Health Care (PHC) Annual PHC 300 Tips (continued) • #5-#7 totals should all be the same and only include individuals 18 and older • #8 subtotals for B should be the sum of B and A + B should equal #1 • #9 individuals may be counted for multiple scenarios and the total should be no less than #1 • #10 list the number of counties served even if not on your SDP and the total clients should equal #1

  50. Primary Health Care (PHC) Annual PHC 300 Tips (continued) • #11individuals may be counted for multiple scenarios and the total should be no less than #1 • Narrative Progress Outcome A. Service Delivery Plan Outcome B. FQHC Coordination C. Medicare Prescription Drug Card/Medicare Part D D. Program Narrative - Optional